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MSK > Lumbar spine Not Finished > Flashcards

Lumbar spine Not Finished Flashcards

1
Q

disc injury is due to acute trauma alone (true or false)

A

degenerative mostly

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2
Q

90% of the time, disc herniations occur at L?

A

L4/L5. L3/4 is second most common

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3
Q

Disc bulge pain looks like ____and disc bulge against nerve root looks like _____

A

dull deep poorly localized, while nerve is sharp

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4
Q

most disc bulges occur in what area of the disc?

A

In posterior lateral aspect of the disc

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5
Q

mechanism of injury for disc pathology: What happens at the muscular level and circulatory level?

A

Body will contract large muscles in response to inflammation that shuts down local muscle fibers. Lack of motion impedes circulation, so irritants do not leave the region

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6
Q

what tight muscles contribute to lumbar disc pathology?

A

hip flexors, hamstrings

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7
Q

Disc pathology stiffness and pain in the AM lasts _____

A

more than 20 min

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8
Q

Easing activities for lumbar disc pain

A

lying down w knees/hips flexed (decreased disc pressure 75%)
meds
walking (circulation to disc)
lumbar extension motion

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9
Q

why do repetitive extension exercises help with leg paresthesias? (known as centralization)

A

When annulus is intact, nucleus/disc contents move anteriorly (anterior translation).

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10
Q

degenerative joint disease leads to ____ of articular surfaces in facets and results in loss of _____. Inflammatory cascade can result in ______.

A

breakdown of lumbar spine facet articular surfaces with loss of cartilage and disc height. Bone spurs/osteophytes can occur

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11
Q

symptomatic lumbar DJD is rarely found in people ____ years old. More common in ____ years old

A

rare in younger than 40 years old. More common in older than 60 years old

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12
Q

physiologically, what happens in lumbar DJD?

A

hyaline cartilage breaks down–> inflammation–> thickening/sclerosis of subchondral bone–> bone spurs/osteophytes–>narrow joint space

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13
Q

does DJD present unilaterally or bilaterally?

A

usually unilaterally in back and glutes (facet joint pain tends to be localized)

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14
Q

what are good ideas for reducing lower back pain?

A

increase thoracic mobility (extension), shoulder extension/retraction, stretch hip flexors, stretch plantarflexors and hamstrings
(also abs)

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15
Q

Is interforaminal stenosis from acute trauma or degeneration?

A

Wear and tear. Injury to joints, ligaments, disc, nerves leads to inflammation of the foramen

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16
Q

Do extension exercises aggravate or ease interforaminal stenosis?

A

aggravate! close down foramen (closing motions)

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17
Q

3/10 people with back pain also have ______

A

radiculopathy. Most cases resolve 1 to 2 months.

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18
Q

leg pain is often worse than back pain for patients with ______

A

radiculopathy

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19
Q

what direction do herniated lumbar discs go?

A

posterior-lateral, impinging nerve roots

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20
Q

What nerve roots are involved usually in radiculopathy?

A

L4-S1 (symptoms below knee)

21
Q

indicators for surgery for patients with lumbar radiculopathy

A

neuro deficit
cauda equine syndrome
bowel/bladder dysfunction
severe unrelenting pain

22
Q

lumbar ligament tears have bad or good prognosis?

A

excellent! over 90% of patients recover 1-2 months

23
Q

80% of people experiencing LBP can be attributed to

A

soft tissue injuries/sprains/strains

24
Q

The weakest point of ligaments for elderly and young is ______-

A

ligament to bone intersection

25
Q

The weakest point of ligaments in adults is often at _______

A

midsubstance (will vary with each individual ligament)

26
Q

why are partial ligament ruptures common? Vs full rupture

A

Bc ligaments are multipennated, resist forces in multiple directions

27
Q

Ligament sprain is usually caused by trauma as opposed to overuse (true or false)

A

true

28
Q

ligament tears have referred pain to LE (true or false)

A

FALSE. Pain is localized and increased with stretching ligament (end range postures)

29
Q

Most common lumbar muscle strain is the _____muscle

A

erector spinae muscle

30
Q

How long does it take for lumbar strains to heal?

A

4-12 weeks. Symptoms of mild strains usually 2-3 weeks. Over 90% recover in 1-2 months

31
Q

In elderly and young, the weakest point of muscle is

A

tendon to bone intersection

32
Q

In most adults, weakest point is at

A

myotendinous junction

33
Q

The major risk factor for LBP is_____

A

history of back pain. **main cause is mismatch workload and patient strength

34
Q

Muscle sprains have what symptoms?

A

-resisted extension moment
-pain that usually does not radiate
-tenderness/spasm
-passive trunk extension is PAIN FREE

35
Q

what 3 pathologies do not like lumbar extension?

A

interforaminal stenosis, spondylolisthesis, and muscle strains

36
Q

Spondylolysis most commonly occurs at

A

L5, then L4

37
Q

Spondylolisthesis most commonly occurs at what level?

A

L5/S1, then L4/5, then L3/4

38
Q

Four grades of spondylolisthesis are

A

1: 0-25%
2: 25-50%
3: 50-75%
4: 75% +

39
Q

5 types of spondylolisthesis

A
  1. dysplastic
  2. isthmic
  3. degenerative
  4. traumatic
  5. pathological (tumor, metastases, metabolic bone disease)
40
Q

dysplastic spondylolisthesis occurs due to

A

congenital -rare, difficult to treat surgically

41
Q

isthmic spondylolisthesis is

A

maybe from stress fracture, shear forces. Most common L5/S1.

42
Q

degenerative spondylolisthesis

A

slippage of superior vertebral segment from facet arthritis

43
Q

traumatic spondylolisthesis

A

acute fracture of facet/pars interarticularis

44
Q

forced extension usually causes spondylolysis (true or false)

A

true (L5, then L4, then L3)

45
Q

spondylolisthesis will always have symptoms (true/false)

A

NO, false. But, if they due, pain in back, legs with increased extension

46
Q

Gold standard for verifying SI articulation pain source

A

intraarticular anesthetic injections

47
Q

What gender is more at risk for SI joint pathology?

A

Women, most common correlation is pregnancy

48
Q

Why is there less referred pain for SI joint pathology?

A

S2-4 (referred pain usually has to do with higher like lumbar)

MSK (8 decks)

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